目的 初步探讨连续血液净化疗法CBP(continuous blood purification)对全身炎症反应综合症(SIRS)及脓毒血症(Sepsis)患者内皮功能损伤标志物的影响。方法 选择复旦大学附属华山医院肾内科15例SIRS或伴Sepsis患者，分别留取CVVH(continuous venous-venous homofiltrtion, 连续静脉静脉血液滤过)治疗前后的血浆，直接检测血栓调节蛋白(sTM，soluble thrombomodulin)、E－选择素、细胞间黏附分子-1(sICAM-1，soluble intercellular adhesion molecule-1)浓度。APACH II评分评价临床疗效。结果 临床转归：8名SIRS组患者，CVVH治疗后第4天APACH II评分较治疗前显著改善(P＜0.01)，而7名Sepsis组患者的APACH II评分更加恶化。SIRS组患者血浆sTM、sICAM-1、sE-选择素浓度显著高于正常对照组(P＜0.01)；Sepsis组患者血浆sTM、sICAM-1、sE-选择素浓度显著高于正常对照和SIRS组(P＜0.01)；CVVH治疗后1周，SIRS组患者sTM、sE-选择素较治疗前明显降低(P＜0.05),而Sepsis组患者无明显降低(P＞0.05)。结论 SIRS/Sepsis患者内皮细胞存在明显的激活和损伤，CVVH治疗能部分改善SIRS患者内皮细胞功能，而对Sepsis患者效果不佳。

Objective Efforts were made to investigate the effects of continuous venous-venous hemofiltration (CVVH) on the markers for endothelial injury in systemic inflammatory response syndrome and sepsis (SIRS/sepsis) patients. Methods Soluble thrombomodulin (sTM), soluble intercellular adhesion molecule-1 (sICAM-1), soluble E-selectin in plasma were measured by ELISA before and after CVVH treatment in 15 SIRS/sepsis patients. APACH II scores were used to evaluate the CVVH effects. Results APACH II scores improved on the 4th day after the treatment in 8 SIRS patients, but worsened in 7 sepsis patients. Plasma sTM, sICAM-1 and E-selectin were significantly higher in SIRS/sepsis patients than in normal controls, and were higher in sepsis patients than in SIRS patients. On the 7th after the treatment, plasma sTM and sE-selectin decreased remarkably in SIRS patients but not in sepsis patients. Conclusion Endothelial activation and injury occur in SIRS/sepsis patients. CVVH can partially improve the endothelial function in SIRS patients but not in sepsis patients.